Cystitis Fact Sheet

Cystitis refers to inflammation of the urinary bladder – the muscular organ that is responsible for collecting and storing urine. Under normal circumstances, urinary bladder is a sterile organ (which means no microorganisms are present in the cavity). Most common cause of cystitis is ascending infection from other parts of the urinary tract.

According to the latest statistics reported by Association of Reproductive Health Professionals (1), investigators suggested that the annual prevalence of cystitis is 60 per 100,000 adults. More than 80,000 males and 1.2 million females are currently living with interstitial cystitis or painful bladder syndrome in United States.

Classic Symptoms of Cystitis

Cystitis patients usually presents with symptoms like:

• Moderate to severe pain in the lower abdomen and flanks. The pain is usually sharp and worsens, when the bladder is full.
• A significant increase in the frequency and urgency of urination is another key symptom of cystitis. Due to increased sensitivity of bladder walls (as a result of active inflammation), the capacity of bladder to hold ur

• ine decreases significantly.
• Pain and pressure in genitals and pelvic region.
• Burning sensation that aggravates while passing urine.
• Pain during intercourse or during ejaculation (in men).
• Ulceration of bladder mucosa that may presents with onset of blood in the urine (cola colored in the urine).
• Fever, nausea, vomiting and shivers are also reported in acute cases.

Symptomatology in the cystitis patients vary and changes with time. In women, symptoms worsen during periods. Poorly managed cystitis greatly compromises the capacity of individuals to perform day-to-day activities; such as occupational and social responsibilities, sexual relationships etc.

Who is at risk of developing Cystitis?

Most cases of mild cystitis are asymptomatic and are diagnosed incidentally on urological investigations for other causes. Certain risk factors that may increase the risk of cystitis are:

• Elderly males and females with impaired immunity and bladder dysfunction.
• Bedridden patients or individuals suffering from chronic neurological or degenerative conditions such as Parkinson’s disease, Dementia and Alzheimer’s disease.
• Individuals who are catheterized are also at much higher risk of developing cystitis
• Sexually active individuals with inadequate genital hygiene; one example is honeymoon cystitis that is seen in newly-wed females.
• Individuals who use birth control pills or use other types of irritants for contraception such as latex condoms, spermicidal jellies etc.
• Males with prostate enlargement and related issues of impaired urinary flow such as urinary stones.

Other risk factors include:

• Pregnancy
• Poor immunity or metabolic derangements such as HIV infection, uncontrolled diabetes etc.

Pathophysiology and Causes

The pathophysiology of Cystitis is usually multifactorial. Most notable causes include:

• Defected or damaged bladder wall due to an injury or disease process that allows urinary substances to cause irritation in the bladder.
• Immune defects: Sometimes, abnormal activation or inflammation of immune system can also presents with cystitis. Such cases are more common in females. Other immune-related conditions are also common in such individuals; such as irritable bowel problems, allergies and fibromyalgia.

Classic causes include:

• Bacterial Invasion: Bacterial cystitis is the most common variety of cystitis. Microorganisms like E Coli are usually present on the skin as part of the normal flora. Any condition that affects the biochemical pH of the urinary tract or alters the immunological defenses can aggravate the risk of ascending infection and colonization of bacterial agents in the urinary bladder.

Other less common causes include:

• Radiation cystitis (common in individuals who undergo radiation therapy for the management of malignant lesions)
• Interstitial cystitis (the cause is largely unknown and reported mostly in females)
• Foreign body cystitis (Presence of a foreign object in the lining of bladder can elicit an inflammatory response that may lead to cystitis).
• Drug induced cystitis (Cystitis due to chemical reaction in response to a drug is referred to as drug-induced cystitis. Most common pharmacological agents include chemotherapeutic drugs like ifosfamide cyclophosphamide).

Diagnosis

The diagnosis is usually clinical or via routine urological and serum tests to assess the signs of infection. Healthcare providers also carry out different tests to identify the source of primary infection such as:

• Urinary Tract Infection
• Kidneys stones
• Endometriosis
• Bladder cancer
• Sexually transmitted disease.

Most reliable diagnostic tools that are employed to identify primary source of inflammation in the urinary bladder are:

• Urine test (Urine Detailed Report (D/R) and Culture Sensitivity testing to identify the drug sensitivity to different antibiotics).
• Biopsy
• Cystoscopy

Treatment

Cystitis treatment options are usually decided after identifying the primary source of infection. If the cause of cystitis is bacterial colonization, antibiotics are usually preferred. For chronic and inflammatory varieties of cystitis, more comprehensive treatment regimen is usually advised.

Some modalities include:

• Self-help Techniques:

Following remedies and interventions can help in reducing the intensity of symptoms and shorten the duration of ailments.

• Dietary modification and limiting the intake of bladder irritants.
• Quitting smoking.
• Pelvic exercises and Bladder retraining techniques can be used to minimize the risk of bacterial colonization as a result of urinary retention.

• Oral medication:

Some OTCs (such as antipyretics) help in relieving symptoms; such as pain and fever; until inflammation subsides.

Other medicines include:

• Antihistamines
• Amitriptyline

• Bladder instillation:

Medicine is filled into bladder for multiple time periods and then emptied. Treatment cycle is about 6-8 weeks.

• Nerve simulation:

If cystitis is due to nerve dysfunction or improper voiding of urine from the bladder (due to disorders of nerves); specialized treatments can be considered such as Electrical Nerve Stimulation.

• Surgery:

If cystitis is due to an organic cause, it is highly recommended to address the primary cause. However, surgical intervention should only be considered if all other options fail.

Which foods and drinks can worsen the symptoms cystitis?

It is believed that certain foods and beverages may worsen the symptoms of cystitis. Therefore it is highly recommended to limit the intake of following foods during active cystitis:

• Tomatoes
• Alcohol
• Chocolate
• Spices
• Drinks having caffeine or citric acid
• Foods with acidic chemistry
• Synthetic sweeteners

It is highly recommended to maintain high intake of Vitamin C rich beverages (especially cranberry juice) and water to alleviate the symptoms and to boost natural immunity.

References:

1. https://www.arhp.org/Publications-and-Resources/Clinical-Proceedings/Screening-Treatment-and-Management-of-ICPBS/Epidemiology

2. Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G., ... & Soper, D. E. (2011). International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical infectious diseases, 52(5), e103-e120.

3. O’Brien, V. P., Hannan, T. J., Schaeffer, A. J., & Hultgren, S. J. (2015). Are you experienced? Understanding bladder innate immunity in the context of recurrent urinary tract infection. Current opinion in infectious diseases, 28(1), 97-105.